Taijiquan & Qigong Winter 2012 Class and Workshop Registration
Preregistration is helpful. Space can be limited.
Please print and mail this registration form with your check payable to
Embrace the Moon, 1716 NW Market, Seattle, WA 98107
We thank you for understanding that all fees, once paid, are non-refundable.
Name
Address
City, State Zip
Phone Print Clearly Email
Emergency Contact Name & Number
Please indicate the classes / workshops you are interested in attending:
 
Please indicate your health concerns:
 
 
What would you like to gain from your classes and workshops?
 
 
Session / Workshop and dates attending:


 
Winter session runs 12 weeks; for mid-term enrollment, contact Kim for pro-rated fee.
Those under 18 or over 70 take 20% off session prices for regular ongoing classes, no further discount on early specials or Beginner's series.

Form & Practice Development Classes (12 Week Series)
1x/week $250
2x/week $375
Unlimited $425
Flex card: 10 for $220 (expires 3 months from date of first use)
Drop-In $25

Which Class(es) will you be joining?:

Beginner's Series (6 Week Series)
1 series - $110
2 series - $170
Unlimited - $215
Drop-In $20

Which class(es) will you be joining?:
 		 
Workshops (see workshop & please specify details such as day & section)


 
Total Enclosed:
(cash or check only)
How did you hear about Embrace the Moon?
Would you like to be added to our confidential email notice for future workshops and classes?
We never sell or share our list. ___ yes ___ no

Return to Embrace the Moon Registration